When is diagnostic thoracentesis indicated in the workup for pleural effusion (fluid on the lungs)?

A diagnostic thoracentesis should be performed if the etiology of the effusion is unclear or if the presumed cause of the effusion does not respond to therapy as expected. Pleural effusions do not require thoracentesis if they are too small to safely aspirate or, in clinically stable patients, if their presence can be explained by underlying congestive heart failure (especially bilateral effusions) or by recent thoracic or abdominal surgery.

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